Surgical instruments and methods

ABSTRACT

Various surgical instruments, implants, and their methods of use are disclosed. The surgical instruments are usable to insert various implants into a patient through an access portal in a minimally-invasive manner. The implants are rotatable between different orientations using the instruments to change the footprint of the implant and allow the implant to be inserted through the minimally-invasive access portal.

BACKGROUND OF THE INVENTION

Spinal stenosis often involves narrowing of the spinal canal andpinching of the spinal cord and nerves, causing pain in the back andlegs. Typically, with age, a person's ligaments may thicken,intervertebral discs may deteriorate, and facet joints may break downcontributing to spinal stenosis. Injury, heredity, arthritis, changes inblood flow, and other causes may also contribute to spinal stenosis.Treatments for such conditions vary, though such treatments typicallyinvolve open surgery to repair tissue and/or allow for implantation ofan implant.

A recent advancement, minimally invasive surgery, is becomingincreasingly important—patient trauma and recovery time is vastlyreduced, amongst other benefits. In general, such surgeries involvemaking a small incision in the skin and tissue of a patient, inserting aminimally-invasive access portal (e.g., a cannula or retractor) in theincision, and subsequently performing surgery through the access portalin a less-intrusive manner. In spinal surgery, as an example, an implantor other device is moved through the access portal and engaged with partof the patient's spine (e.g., to assist with fusion, stabilization,etc.). Yet, it is often difficult to manipulate the implant or otherdevice through the access portal. It is also desirable to use an accessportal with the smallest exposure (e.g., diameter) possible so that thesurgery exacts the least trauma on the patient. Current instruments andimplants are cumbersome in this regard, and make it difficult to usesmaller-footprint access portals.

Therefore, there exists a need for improved surgical instruments,implants, and methods to overcome the foregoing deficiencies.

BRIEF SUMMARY OF THE INVENTION

A first aspect of the invention provides a surgical system comprising animplant and a first instrument. The first instrument comprises a hollowbody and an actuation member movably engaged to a locking mechanism,wherein movement of the actuation member from a first position to asecond position causes the locking mechanism to move from an unlockedstate to a locked state. The first instrument further includes aconnection mechanism engageable with the implant, wherein, afterengagement of the connection mechanism with the implant, movement of thelocking mechanism from its unlocked state to its locked state locks theconnection mechanism to the implant, and movement of the lockingmechanism from its locked state to its unlocked state unlocks theconnection mechanism from the implant, the implant being rotatable whileengaged to the connection mechanism from a first orientation in whichthe implant has a first footprint in a horizontal direction to a secondorientation in which the implant has a second footprint in thehorizontal direction smaller than the first footprint. The firstinstrument also has an activation sleeve engaged to a pivoting member,the pivoting member having a surface shaped to contact the implant andretain the implant in its second orientation.

In embodiments of this first aspect, the pivoting member is engaged tothe activation sleeve via a spring that biases the pivoting member intoa first orientation transverse to the activation sleeve. Further, thesystem may include a drive shaft operatively engaged to the actuationmember and to the locking mechanism, the actuation member comprising aknob rotatably engaged to the instrument, wherein rotation of the knobrelative to the instrument causes longitudinal movement of the driveshaft, thereby resulting in movement of the locking mechanism from itsunlocked state to its locked state.

A second aspect of the invention includes a method of performing surgerycomprising (i) engaging a first surgical instrument with an implant,(ii) moving a pivoting member of the first surgical instrument from afirst distal position to a second relatively more proximal position,(iii) rotating the pivoting member from a first orientation in which thepivoting member occupies a first footprint in a horizontal direction toa second orientation in which the pivoting member occupies a secondfootprint in the horizontal direction smaller than the first footprint,(iv) rotating the implant from a first orientation in which the implantoccupies a first footprint in the horizontal direction to a secondorientation in which the implant occupies a second footprint in thehorizontal direction smaller than the first footprint, (v) subsequentlybiasing a surface of the pivoting member against the implant so that thepivoting member and the implant are secured in their secondorientations, (vi) inserting the instrument with the implant attached inits second orientation through an access portal extending through skinand tissue of a patient, (vii) after the implant passes through theaccess portal, rotating the pivoting member from its second orientationback to its first orientation, (viii) engaging the pivoting member withthe implant so that the implant is rotated from its second orientationback to its first orientation, and (ix) engaging the implant to anatomyin the patient. Although some steps may be numbered in the disclosure,no ordering is implied by the numbering and certain steps of the methodmay be performed in a different order than set forth by the numbering.

In embodiments of the second aspect, the method further comprises (i)inserting a second surgical instrument through the first surgicalinstrument, (ii) engaging the second surgical instrument with theimplant, and (iii) moving the second surgical instrument while engagedto the implant so that the implant either expands or contracts.

A third aspect of the invention includes a surgical system comprising animplant and a first instrument. The first instrument includes a body andan actuation member movably engaged to a locking mechanism, whereinmovement of the actuation member from a first position to a secondposition causes the locking mechanism to move from an unlocked state toa locked state. The instrument also has a connection mechanismengageable with the implant, wherein, after engagement of the connectionmechanism with the implant, movement of the locking mechanism from itsunlocked state to its locked state locks the connection mechanism to theimplant, and movement of the locking mechanism from its locked state toits unlocked state unlocks the connection mechanism from the implant,the implant being rotatable while engaged to the connection mechanismfrom a first orientation in which the implant has a first footprint in ahorizontal direction to a second orientation in which the implant has asecond footprint in the horizontal direction smaller than the firstfootprint. The first instrument further comprises an activation sleeveengaged to a pivoting member, the pivoting member being rotatablerelative to the activation sleeve from a first orientation in which thepivoting member has a first footprint in the horizontal direction to asecond orientation in which the pivoting member has a second footprintin the horizontal direction smaller than the first footprint, whereinthe pivoting member has a surface shaped to contact the implant andretain the implant in its second orientation when the pivoting member isin its second orientation.

In certain embodiments, the pivoting member is movable in a longitudinaldirection from a first distal position to a second more proximalposition and, when the pivoting member is in the first distal positionwith the surface of the pivoting member engaged to the implant, thepivoting member and the implant are fixedly secured their secondorientations.

In a fourth aspect of the invention, a surgical instrument for use inminimally invasive surgery is provided, the surgical instrumentcomprising a rotational member, a first sliding member, a second slidingmember, a compressible member, and a pivoting member, wherein anuninterrupted cannulation extends through each of the rotational member,first sliding member, second sliding member, compressible member andpivoting member, the cannulation adapted to allow passage of a secondinstrument therethrough. Embodiments of this fourth aspect may encompasswherein the pivoting member includes an end adapted to engage with animplant and rotate the implant from a first position to a secondposition. In the first position, the implant may have a first footprintand, in the second position, the implant may have a second footprintthat is smaller than the first footprint. In other embodiments, thesecond instrument is engageable with an implant to expand or contractthe implant.

The instruments and methods provided herein are useful for insertingimplants, in a minimally-invasive manner, through a relatively smallaccess portal in a first orientation where the implant has a firstfootprint, and then moving the implant into a second orientation oncethe implant passes through the access portal so that the implant has asecond footprint larger than the first footprint. Thus, the trauma andtime frame of a surgical procedure can be improved.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of the presentinvention and of the various advantages thereof can be realized byreference to the following detailed description in which reference ismade to the accompanying drawings in which:

FIG. 1 is an exploded view of a surgical instrument according to anembodiment of the invention.

FIGS. 2A-C are perspective, top, and cross-sectional views of theinstrument of FIG. 1 attached to an implant, with the instrument andimplant in a first orientation.

FIGS. 3A-C are perspective, top, and cross-sectional views of theinstrument of FIG. 1 attached to an implant, with the instrument andimplant in a second orientation.

FIGS. 4A-B are perspective and cross-sectional views of the surgicalinstrument of FIG. 1 in use with a second surgical instrument foractuating the implant.

FIGS. 5A-B are perspective and exploded views of an embodiment of animplant that is usable with the surgical instruments of FIG. 1-4B.

FIGS. 6A-C are side, top, and bottom views of the instrument of FIG. 1in use with an alternate implant.

DETAILED DESCRIPTION

In describing certain aspects of the present invention, specificterminology will be used for the sake of clarity. However, the inventionis not intended to be limited to any specific terms used herein, and itis to be understood that each specific term includes all technicalequivalents, which operate in a similar manner to accomplish a similarpurpose.

FIGS. 2A-C depict a surgical instrument 10, according to an embodimentof the invention. As described in more detail below, instrument 10 maybe used to pivot an implant 4100 (FIGS. 5A-B) into differentorientations (e.g., a “vertical” orientation, and a “horizontal”orientation) for insertion through an access portal, such as a cannula,retractor, etc. (not shown). Pivoting implant 4100 in this manner usinginstrument 10 allows for easy insertion through a relatively smallaccess portal, resulting in less trauma to the patient, reduced surgerytime, and reduced recovery time. Instrument 10 is therefore effective atimplanting various implants (e.g., implant 4100) through an accessportal in a minimally-invasive manner.

Although a variety of implants are usable with the instruments disclosedherein, Applicant has developed a number of implants that areparticularly suitable for use with instrument 10. As an example, variousimplants are disclosed in Applicant's co-pending application U.S. PatentPub. No. 2013/0144339 (“the '339 Publication”), filed as U.S.application Ser. No. 13/679,986, which is hereby incorporated byreference herein. It is understood that any of the implants disclosed inthe '339 Publication are usable with the instruments described herein,although a particular embodiment of an implant from the '339 Publicationis referred to throughout the present application as an example. Theparticular implant of the '339 Publication referenced herein is implant4100 of FIGS. 40A-42B. FIGS. 40A-B of the '339 Publication have beenreproduced herein as FIGS. 5A-B, with the same reference numerals beingused, for ease of reference.

Continuing with the exemplary implant, as reproduced in FIGS. 5A-B,implant 4100 includes a clamp assembly 4122 comprising wings 4110(identified individually as wings 4110 a, 4110 b), and an actuatorassembly 4102 for actuating wings 4110. Implant 4100 can be implanted,for example, between the spinous processes of adjacent vertebrae of apatient, in the manner described in the '339 Publication (e.g., with theimplant 4110's wings clamped to the processes). Actuator assembly 4102includes an actuator 4132 having a threaded shaft, an actuator adjuster4134, a cover 4140, a body 4144, and guides 4130 a, 4130 b. Guides 4130a, 4130 b are attached to wings 4110 (e.g., via receiving features 4152a, 4152 b), and rotation of actuator adjuster 4134 in a first directioncauses actuator 4132 to move outward away from guides 4130 a, 4130 bwithin body 4144, allowing wings 4110 to be at their maximum separation,while rotation of actuator adjuster 4134 in a second direction causesactuator 4132 to move inwards towards guides 4130 a, 4130 b within body4144, resulting in wings 4110 moving towards each other to a compressedstate. FIG. 42A of the '339 Publication illustrates wings 4110 in aseparated state, while FIG. 42B illustrates wings 4110 in a compressedstate (e.g., for attachment to a patient's spinous processes). Theparticular means by which wings 4410 are moved toward and away from eachother is described in more detail in the '339 Publication.

Actuator adjuster 4134 also includes one or more female mating features160 for engaging with a tool 140 (described below). Tool 140 is used torotate actuator adjuster 4134 and cause expansion or contraction ofwings 4110 of implant 4100, as detailed above. Additionally, body 4144includes female mating features 170 for engaging with a part ofinstrument 10, as described in more detail below.

Referring now to FIG. 1, in an embodiment, instrument 10 is engageablewith an implant, for example implant 4100, and usable to insert implant4100 through a minimally-invasive access portal. In this regard,instrument 10 includes a spring clip 60 for attaching to implant 4110(or any other implant, including any of those of the '339 Publication,as described above). Spring clip 60 has spring arms 62 that are biasedoutwards and are engageable with implant 4110 via female mating features170 on body 4144. In particular, arms 62 have hooks 64 that grasp femalemating features 170 of body 4144 to engage instrument 10 to implant4100.

Continuing with this embodiment, a sleeve 70 is positionable over springclip 60 and is movable relative thereto for releasably locking arms 62to female mating features 170, and thus implant 4100. As an example,sleeve 70 includes an opening 74 through which arms 62 may extend.Sleeve 70 is moveable from a first position in which arms 62 extend outof opening 74 and are not covered or are only partly covered by sleeve70, thereby allowing arms 62 to assume their biased orientation (e.g.,spaced apart), to a second position in which sleeve 70 covers part orall of arms 62 causing arms 62 to move toward each other. In use, arms62 are engageable with female mating features 170 of implant whilesleeve 70 is in its first position. Alternatively, in the firstposition, arms 62 can be positioned adjacent female mating features 170.Sleeve 70 is then movable to its second position to cause arms 62 tomove towards each other, or at least prevent arms 62 from moving awayfrom each other. In the second position, hooks 64 securely engage femalemating features 170, and arms 62 are locked in position in engagementwith female mating features 170. In other words, in the second position,sleeve 70 prevents arms 62 and hooks 64 from disengaging with femalemating features 170 since sleeve 70 covers arms 62 and arms 62 areunable to move outwards away from each other.

Movement of sleeve 70 from its first position to its second position isachieved by a user interface, such as a rotatable knob 22 of instrument10. Indeed, in an embodiment, a set of drive rails 50 are attached(e.g., welded) to slots 72 on sleeve 70 and rotation of knob 22 causesmovement of drive rails 50 and sleeve 70. As an example, drive rails 50extend from sleeve 70 and are connected to a threaded drive insert 36positioned in a cavity 23 of knob 22. An unthreaded part 38 of driveinsert 36 includes a set of cutouts or recesses 40, and drive rails 50are securely attached to drive insert 36 within such recesses 40 (e.g.,by welding). A threaded knob insert 30 is also provided within cavity 23of knob 22, which is configured to receive the threaded part of driveinsert 36. In an embodiment, cavity 23 extends to a proximal bore 26within knob 22, and knob insert 30 is securely affixed (e.g., welded oradhered) within internal cavity 23 and proximal bore 26, as shown in thecross-section of FIG. 2C. In this manner, rotation of knob 22 causesrotation of knob insert 30 which, due to its association with driveinsert 36, causes movement of drive insert 36 in opposing directions.

Continuing with the embodiment shown in FIG. 1, a handle 20 with agripping part 44 is also provided with instrument 10. First and secondprojections 46, 52 extend from gripping part 44, and a hollow boreextends through handle 20 (and necessarily projections 46, 52 andgripping part 44). The dimension of the hollow bore is such that firstprojection 46 can receive drive insert 36 and knob insert 30 therein,while second projection 52 receives drive rails 50 therein. Drive rails50 and drive insert 36 are also movable relative to handle 20 within itshollow bore upon rotation of knob 22, as noted above. In particular,knob 22 includes openings 24 that receive pins 42. Handle 20 also has acircumferential groove 48 that extends around part or all of firstprojection 46 for receiving pins 42. As such, pins 42 can be placed inopenings 24 so that pins 42 ride in circumferential groove 48 and allowknob 22 to rotate about handle 20 without relative axial movement. Inother words, knob 22 can rotate relative to handle 20 without slidinglongitudinally relative to handle 20. In this way, to cause movement ofsleeve 70 from its first position to its second position, or vice versa,a user may simply rotate knob 22 relative to handle 20, causing threadedknob insert 30 to rotate and force drive insert 36 in a proximal ordistal direction within handle 20. Since drive rails 50 are attached todrive insert 36 and sleeve 70, such movement causes sleeve 70 to movefrom its first position to its second position, or vice versa. In anembodiment, rotation of knob 22 in a clockwise direction causes distalmovement of drive insert 36 (and consequently drive rails 50 and sleeve70), while rotation of knob 22 in a counterclockwise direction causesproximal movement of drive insert 36 (and consequently drive rails 50and sleeve 70). Thus, a user is afforded a simplified mechanism formoving sleeve 70 from its first position to its second position so as tolock or unlock arms 62 of spring clip 60. Instrument 10 can thereforeeasily be engaged or disengaged from implant 4100 in a secure manner.

Spring clip 60 may additionally include slots 66 for accommodatingand/or guiding drive rails 50 during rotation of knob 22. In anembodiment, drive rails 50 are not securely attached to slots 66 and,instead, drive rails 50 slide along slots 66. Drive rails are thereforemovable relative to and are in part guided by slots 66 of spring clip 60during rotation of knob 22.

Continuing with the embodiment of FIG. 1, instrument 10 further includesa mechanism for rotating implant 4100 between vertical and horizontalorientations. A “horizontal” orientation can be one in which implant4100 is transverse to a longitudinal axis of instrument 10, for exampleby about anywhere between about five to about ninety degrees)(5-90°). A“vertical” orientation may be one in which implant 4100 is more or lessin line with or parallel to the longitudinal axis, for example anywherebetween about zero to about fifteen degrees)(0-15°). In the horizontalorientation, implant 4100 has a footprint that is larger than afootprint of implant 4100 in the vertical orientation. Such rotationfacilitates movement of implant 4100 through a small access portal—whileimplant 4100 is in the vertical orientation—as well as implantation ofimplant 4100 in an appropriate horizontal orientation between apatient's spinous processes after passage through the access portal.

One example of a swivel tip 100 is shown in FIGS. 2A-3C. Swivel tip 100is capable of placing implant 4100 in its first “vertical” (FIGS. 3A-C)and second “horizontal” orientations (FIGS. 2A-C). As shown in FIG. 1,swivel tip 100 includes first and second arms 104, 106, each having arecess 110 and a bar 108 connecting arms 104, 106. Swivel tip 100 alsohas a set of projections 102 arranged on an inside part of each arm 104,106 for attaching swivel tip 100 to an activation sleeve 80.

In one embodiment, activation sleeve 80 is a hollow sleeve designed tofit over second projection 52 of handle 20 at a first end 84, andreceive spring clip 60 and sleeve 70 at a second end 86. Activationsleeve 80 also includes a gripping part 82 and openings 88 and, oncefirst end 84 is positioned over second projection 52 of handle 20, pins90 are insertable into openings 88 so as to ride within a set ofchannels 54 of handle 20. Activation sleeve 80 can therefore reciprocaterelative to handle 20 in a controlled manner by an amount equal to thelength of channels 54.

Activation sleeve 80 is also associated with an activation sleeve collar120, which has a main body 122 with openings 124, a projection 128extending from main body 122, and side channels 126 disposed on mainbody 122. Pins 90 are insertable into openings 88 of activation sleeve80, through channels 54 of handle 20, and subsequently into openings 124of activation sleeve collar 120. Additionally, a spring 130 may bepositioned in a pocket 58 of handle 20 (FIGS. 2C and 3C) and also overprojection 128 of activation sleeve collar 120 to control movement ofactivation sleeve 80. In particular, spring 130 is arranged in pocket 58to contact an end/step thereof and also a step formed between main body122 and projection 128 of activation sleeve collar 120. With pins 90inserted into openings 88, through channels 54, and subsequently intoopenings 124 of activation sleeve collar 120, spring 130 is then able tobias activation sleeve 80 in a distal direction. In other words,activation sleeve 80 is predisposed to be in a distal positioncorresponding to the maximum length of spring 130 as spring 130 acts onactivation sleeve collar 120. Due to activation sleeve collar 120'sattachment to activation sleeve 80 via pins 90, spring 130 forcesactivation sleeve 80 distally.

To move activation sleeve 80 proximally, a user may opt to graspgripping part 82 of activation sleeve 80 and pull it in a proximaldirection against the force of spring 130. This causes the step ofactivation sleeve collar 120 to act on and compress spring 130, movingcollar 120 and thus activation sleeve 80 attached thereto in a proximaldirection. Through the action of spring 130, and the connection betweenactivation sleeve 80 and activation sleeve collar 120 via pins 90, auser is therefore able to easily move activation sleeve 80 proximally bypulling on gripping part 82, and also move activation sleeve 80 distallyby simply releasing gripping part 82. Such movement of activation sleeve80 facilitates or causes corresponding movement of swivel tip 100, asdescribed below.

Further to this embodiment, second end 86 of activation sleeve 80, asshown in FIG. 1, includes a set of openings 92 for receiving projections102 of swivel tip 100. Additionally, a set of torsion springs 112 arepositionable over projections 102 of swivel tip 100 and, when swivel tip100 is engaged to activation sleeve 80 through openings 92, torsionsprings 112 act to bias swivel tip 100 to a horizontal orientation, asshown in FIGS. 2A-C. Swivel tip 100 can be moved to a verticalorientation to coincide with the vertical orientation of implant 4100 bypulling on activation sleeve 80 via its gripping part 82 to moveactivation sleeve 80 and collar 120 proximally against spring 130. Hereagain, a “horizontal” orientation may be one in which swivel tip 100 istransverse to the longitudinal axis of instrument 10, for example,within a range of anywhere between about five to about ninety degrees(5-90°). A “vertical” orientation may be one in which swivel tip 100 ismore or less in line with the longitudinal axis of instrument 10, forexample anywhere between about zero to about fifteen degrees (0-15°).

In an embodiment, swivel tip 100 needs to be manually placed in thevertical orientation after retraction of activation sleeve 80 due to theconstant biasing of torsion springs 112. In other words, once activationsleeve 80 is pulled proximally a sufficient distance, the user mustmanually rotate swivel tip 100 to its vertical orientation. In anembodiment, activation sleeve 80 may include a lock or other mechanism(not shown) for retaining sleeve 80 in its proximal position. The lock(not shown) may be released using a release mechanism (not shown) aftermoving swivel tip 100 to its vertical orientation. The interaction ofswivel tip 100 with an implant, such as implant 4100, will be discussedbelow.

FIGS. 4A-B illustrate one embodiment of an instrument 140 used foractuating an implant, such as implant 4100. Instrument 140 includes ahandle 142 and a drive shaft 144 having ears 146 at an end thereof.Drive shaft 144 is sized to extend through instrument 10, in particularthrough a knob cap 28 disposed inside knob insert 30. Indeed, in anembodiment, knob cap 28 is disposed inside knob insert 30, as shown inFIGS. 2C and 3C, and knob cap 28 has a diameter that is only slightlygreater than a diameter of drive shaft 144. Thus, drive shaft 144 ofinstrument 140 is able to pass through knob cap 28 and, owing to thecontinuous cannulation through instrument 10 (e.g., through knob 22,knob insert 30, drive insert 36, handle 20, activation sleeve 80, spring130, activation sleeve collar 120, spring clip 60, and sleeve 70, eachof which is hollow), instrument 140 is movable relative to and withininstrument 10. Once inserted inside instrument 10 and moved distally sothat ears 146 are adjacent implant 4100, instrument 140 is engageablewith implant 4100 to cause compression or distraction of implant 4100.In particular, ears 146 can engage female mating features 160 ofactuator adjuster 4134 and, upon rotation of instrument 140 relative toand within instrument 10, actuator adjuster 4134 is rotated to causecompression or distraction of wings 4110 of implant 4100.

Instrument 10 is usable along with instrument 140—and optionally anaccess portal such as a cannula, retractor, or the like—to insertimplant 4100 into the body of a patient in a minimally-invasive manner,as follows. In an embodiment, knob 22 may first be rotated in acounterclockwise direction to cause likewise counterclockwise rotationof knob insert 30, resulting in proximal movement of drive insert 36(and drive rails 50 and sleeve 70 attached thereto). In this condition,arms 62 of spring clip 60 may extend from opening 74 of sleeve 70 withsleeve 70 in its first position not covering or only covering a portionof arms 62. Arms 62 of spring clip 60 are therefore able to, forexample, move slightly (e.g., outwards) and engage with female matingfeatures 170 of body 4144 of implant 4100. As arms 62 pass over femalemating features 170, hooks 64 engage with female mating features 170,thereby engaging instrument 10 with implant 4110. Then, knob 22 may berotated clockwise to cause likewise clockwise rotation of knob insert30, resulting in distal movement of drive insert 36 (and drive rails 50and sleeve 70 attached thereto). Knob 22 is rotated until resistance isfelt and sleeve 70 is in its second position covering arms 62 of springclip 60 and placing arms 62 in a locked state. In other words, withsleeve 70 covering arms 62, arms 62 are locked in engagement with femalemating features 170 of implant 4110 and instrument 10 is securelyengaged with implant 4100. In this condition, implant 4100 and swiveltip 100 are in their horizontal orientations with activation sleeve 80biased in a distal direction by way of spring 130. Indeed, spring 130 ispositioned about projection 128 of activation sleeve collar 120 andwithin pocket 58 of handle 20. Pins 90 are also inserted throughopenings 88 of activation sleeve 80, through channels 54 in handle 20,and into openings 124 of activation sleeve collar 120. As spring 130acts on activation sleeve collar 120 (e.g., the step between main body124 and projection 128), collar 120 and consequently activation sleeve80 are forced in a distal direction.

To move swivel tip 100 and implant 4100 from their horizontalorientations to their vertical orientations—for insertion through anaccess portal in a minimally-invasive manner—the user simply pullsgripping part 82 of activation sleeve 80 to move activation sleeve 80proximally against the force of spring 130. In particular, activationsleeve collar 120 moves proximally against spring 130, while beingguided by pins 90 inserted through openings 88 of activation sleeve 80and channels 54 of handle 20. As activation sleeve 80 moves proximally,swivel tip 100 also moves proximally creating sufficient spacing fromimplant 4100 for swivel tip 100 to be rotated to its verticalorientation, as shown in FIGS. 3A-C. In an embodiment, swivel tip 100must be rotated manually against the action of torsion springs 112,although it is contemplated that an automatic mechanism may be providedto move swivel tip 100 to its vertical orientation. With swivel tip 100in its vertical orientation, implant 4110 can be rotated to its verticalorientation so that the curved ends of wings 4110 a, 4110 b nest inrecesses 110 of arms 104, 106 of swivel tip 100. In an embodiment,implant 4100 must be rotated manually to its vertical orientation,although it is contemplated that an automatic mechanism may be providedto move implant 4100 to its vertical orientation. At this point,activation sleeve 80 may be released so that recesses 110 of swivel tip100 are forced distally by the action of spring 130 against wings 4110a, 4110 b, thereby securing swivel tip 100 and implant 4100 in theirvertical orientations. In an embodiment, activation sleeve 80 mayinclude a set of stops 81 that form roughly an L-shape near swivel tip100, and such stops 81 may act to help prevent rotation of swivel tip100 and implant 4100 from their vertical orientation when activationsleeve 80 is released.

With implant 4100 and swivel tip 100 in their vertical orientations,instrument 10 with implant 4100 attached can be inserted through theminimally-invasive access portal. Since implant 4100 does not have alarge footprint in its vertical orientation, it is possible to insertinstrument 10 and implant 4100 through a relatively small access portal(e.g., an access portal having a diameter that is slightly larger thanthe footprint of implant 4100 in its vertical orientation). As implant4100 approaches the surgical site, which in some embodiments is thespinal column of a patient, in particular the spinous processes, implant4100 may exit the access portal and instrument 10 may be actuated tocause implant 4100 and swivel tip 100 to rotate back to their horizontalorientations. In particular, after implant 4100 exits beyond the extentof the access portal (e.g., the tips of the retractor blades or thecannula), the user may pull gripping part 82 of activation sleeve 80proximally once more to cause swivel tip 100 to move proximally awayfrom wings 4110 of implant 4100. With sufficient clearance between wings4110 and swivel tip 100, torsion springs 112 may then cause swivel tip100 to automatically assume its horizontal orientation. In other words,torsion springs 112, due to their natural bias, cause swivel tip 100 torotate from its vertical orientation to its horizontal orientation. Thiscauses swivel tip 100 to disengage from wings 4110 of implant 4100 andassume its horizontal orientation, while implant 4100 may remain in itsvertical orientation.

Then, after release of gripping part 82, activation sleeve 80 can snapback to its normal distal position due to the force borne on activationsleeve collar 120 via spring 130. Such action causes swivel tip 100—inits horizontal orientation—to contact wings 4110 of implant 4100 androtate implant 4100 from its vertical orientation (if it did not alreadyrotate) to its horizontal orientation, as shown in FIGS. 2A-C. Since asurface of swivel tip 100 contacts wings 4110 of implant 4100 with forceduring this process (e.g., due to the action of spring 130 and themovement of swivel tip 100 distally), implant 4100 may be securelyretained in its horizontal orientation. Stated differently, spring 130may be designed to provide a sufficient amount of force against implant4100 via contact between swivel tip 100 and wings 4110, such thatimplant 4100 remains securely in its horizontal orientation forimplantation at the surgical site. With swivel tip 100 contacting wings4110—both in their horizontal orientation, as shown in FIGS.2A-C—neither swivel tip 100 nor implant 4100 can rotate to theirvertical orientations. Both swivel tip 100 and implant 4100 are securelyin the horizontal orientation for implantation at the surgical site.

With implant 4100 in its horizontal orientation, wings 4110 can bepositioned about the patient's spinous processes, in the mannerdescribed in the '339 Publication. Then, to secure implant 4100 to thepatient's spinous processes, instrument 140 is used. In a particularembodiment, the user grasps handle 142 and inserts drive shaft 144through instrument 10, specifically through knob cap 28 and the rest ofthe continuous cannulation of instrument 10, so that ears 146 engagefemale mating features 160 of actuator adjuster 4134. Due to knob cap28's diameter, which is only slightly greater than the diameter of driveshaft 144, instrument 140 can be inserted through instrument 10 in acontrolled manner. The user rotates handle 142 with ears 146 engaged tofemale mating features 160, causing actuator adjuster 4134 to rotate andmove actuator 4132 inwards towards wings 4110 within body 4144,resulting in wings 4110 moving towards a compressed state. Wings 4110can then be clamped to the patient's spinous processes with sufficientforce to ensure implant 4100 is stably implanted in the patient. Suchclamping is described more particularly in the '339 Publication.

Instrument 140 is subsequently removed from instrument 10 once implant4100 is secure. The user may then rotate knob 22 counterclockwise sothat sleeve 70 moves in a proximal direction back to its first position.Arms 62 of spring clip 60 are then free to disengage with female matingfeatures 170 of body 4144, for instance simply by the user pullingproximally on gripping part 44 of handle 20 and causing hooks 64 toslide off female mating features 170. In other words, in its firstposition sleeve 70 does not cover or only partly covers arms 62 ofspring clip 60 and, by pulling proximally on handle 20, the user cancause hooks 64 to simply slide off female mating features 170 todisconnect instrument 10 from implant 4100. With the above procedure,implant 4100 is implanted on the patient's spinous processes with lesstrauma, decreased operating time, and decreased recovery time due to theprocedure's minimally-invasive nature.

In the devices depicted in the figures, certain structures arereferenced. It is understood that other equivalent structures may beused. As an example, although knob 22 is described as being connected tohandle 20 via two (2) pins 90 engaged in groove 48, it is contemplatedthat a single pin or more than two (2) pins 90 could be used.Additionally, groove 48 may extend entirely around first projection 46of handle 20, or it may extend only partly around first projection 46.Further, biasing members other than spring 130 can be used in instrument10 (e.g., a flexible/compressible cylinder, etc.)

Additionally, it is contemplated that instruments 10, 140 can be usedwith different types of implants. As an example, FIGS. 6A-C illustrateinstrument 10 in use with a corpectomy cage 200. Corpectomy cage 200includes a first body 202 and a second body 204 that is threaded andreceived within first body 202. Rotation of second body 204 relative tofirst body 202 causes expansion or contraction of corpectomy cage 200(e.g., to correspond to the size of a removed vertebral body of thepatient). Additionally, corpectomy cage 200 includes bone-contactingsurfaces 206 for contacting vertebral endplates once implanted.

As shown in FIG. 6A, corpectomy cage 200 can be placed in a horizontalorientation much like implant 4100 above. In the horizontal orientation,swivel tip 100 is also in a horizontal orientation contacting corpectomycage 200. Further, corpectomy cage 200 and swivel tip 100 can be movedto a vertical orientation, much in the same way as detailed previously.Here, activation sleeve 80 may be retracted, and then swivel tip 100 andcorpectomy cage 200 moved to their vertical orientations (e.g.,manually) for insertion through an access portal. In this condition,arms 104, 106 of swivel tip 100 contact one of bone-contacting surfaces206 of corpectomy cage 200 to secure cage 200 in its verticalorientation. As with above, after being moved through the access portal,activation sleeve 80 can be retracted, swivel tip 100 moved back to itshorizontal orientation, and corpectomy cage 200 also moved to itshorizontal orientation for implantation between first and secondvertebrae of the patient (e.g., after an intermediate vertebrae isremoved, as is common in corpectomy procedures). Additionally,instrument 140 (or another instrument, not shown) may then be insertedthrough instrument 10 to expand or contract corpectomy cage 200. Thus,it is to be appreciated that instruments 10, 140 are usable with avariety of implants in the manner discussed above.

Although aspects of the invention herein have been described withreference to particular embodiments, it is to be understood that theseembodiments are merely illustrative of certain features of the presentinvention. It is therefore to be understood that numerous modificationsmay be made to the illustrative embodiments and that other arrangementsmay be devised without departing from the spirit and scope of thepresent invention as defined by the appended claims. For instance, thefeatures described in connection with individual embodiments may beshared with others of the described embodiments.

It will also be appreciated that the various dependent claims and thefeatures set forth therein can be combined in different ways thanpresented in the initial claims. In particular, each feature from thedependent claims may be shared with other features of other claims, tothe extent technologically feasible, as if the claims were written inmultiple dependent format.

1. A surgical system comprising: an implant; a first instrumentcomprising: a hollow body; an actuation member movably engaged to alocking mechanism, wherein movement of the actuation member from a firstposition to a second position causes the locking mechanism to move froman unlocked state to a locked state; a connection mechanism engageablewith the implant, wherein, after engagement of the connection mechanismwith the implant, movement of the locking mechanism from its unlockedstate to its locked state locks the connection mechanism to the implant,and movement of the locking mechanism from its locked state to itsunlocked state unlocks the connection mechanism from the implant, theimplant being rotatable while engaged to the connection mechanism from afirst orientation in which the implant has a first footprint in ahorizontal direction to a second orientation in which the implant has asecond footprint in the horizontal direction smaller than the firstfootprint; and an activation sleeve engaged to a pivoting member, thepivoting member having a surface shaped to contact the implant andretain the implant in its second orientation.
 2. A surgical system asclaimed in claim 1, wherein the pivoting member is engaged to theactivation sleeve via a spring that biases the pivoting member into afirst orientation transverse to the activation sleeve.
 3. A surgicalsystem as claimed in claim 2, wherein the pivoting member is pivotableto a second orientation substantially in line with the instrument andthe surface of the pivoting member is engageable with the implant onlywhile the pivoting member is in its second orientation.
 4. A surgicalsystem as claimed in claim 3, wherein the pivoting member is movable ina longitudinal direction from a first distal position to a second moreproximal position and, when the pivoting member is in the first distalposition with the surface of the pivoting member engaged to the implant,the pivoting member and the implant are fixedly secured in their secondorientations.
 5. A surgical system as claimed in claim 4, wherein, withthe surface of the pivoting member engaged to the implant, movement ofthe pivoting member from its first distal position to its secondproximal position causes the pivoting member to disengage from theimplant and automatically pivot from its second orientation to its firstorientation.
 6. A surgical system as claimed in claim 4, wherein thepivoting member is biased towards its first distal position via aspring.
 7. A surgical system as claimed in claim 1, further comprising adrive shaft operatively engaged to the actuation member and to thelocking mechanism, the actuation member comprising a knob rotatablyengaged to the instrument, wherein rotation of the knob relative to theinstrument causes longitudinal movement of the drive shaft, therebyresulting in movement of the locking mechanism from its unlocked stateto its locked state.
 8. A surgical system as claimed in claim 1, whereinthe connection mechanism comprises an arm with a hook that is engageableand disengageable with the implant, and wherein movement of the lockingmechanism from its unlocked state to its locked state results insecurely locking the arm and hook to the implant.
 9. A surgical systemas claimed in claim 1, further comprising a second instrument having ashaft that is insertable through the hollow body of the firstinstrument, the shaft being engageable with the implant, whereinrotation of the shaft while within the hollow body and engaged to theimplant causes expansion or contraction of the implant.
 10. A method ofperforming surgery comprising: engaging a first surgical instrument withan implant; moving a pivoting member of the first surgical instrumentfrom a first distal position to a second relatively more proximalposition; rotating the pivoting member from a first orientation in whichthe pivoting member occupies a first footprint in a horizontal directionto a second orientation in which the pivoting member occupies a secondfootprint in the horizontal direction smaller than the first footprint;rotating the implant from a first orientation in which the implantoccupies a first footprint in the horizontal direction to a secondorientation in which the implant occupies a second footprint in thehorizontal direction smaller than the first footprint; subsequentlybiasing a surface of the pivoting member against the implant so that thepivoting member and the implant are secured in their secondorientations; inserting the instrument with the implant attached in itssecond orientation through an access portal extending through skin andtissue of a patient; after the implant passes through the access portal,rotating the pivoting member from its second orientation back to itsfirst orientation; engaging the pivoting member with the implant so thatthe implant is rotated from its second orientation back to its firstorientation; and engaging the implant to anatomy in the patient.
 11. Amethod of performing surgery as claimed in claim 10, further comprising(i) inserting a second surgical instrument through the first surgicalinstrument, (ii) engaging the second surgical instrument with theimplant, and (iii) moving the second surgical instrument while engagedto the implant so that the implant either expands or contracts.
 12. Amethod of performing surgery as claimed in claim 10, further comprisingmoving a locking mechanism of the first instrument from an unlockedstate to a locked state so as to lock a connection mechanism to theimplant and securely engage the implant with the first instrument.
 13. Amethod of performing surgery as claimed in claim 12, further comprisingrotating a knob of the first instrument so as to move the lockingmechanism between its unlocked and locked states.
 14. A method ofperforming surgery as claimed in claim 10, further comprising moving aspring-loaded activation sleeve of the first surgical instrument from afirst distal position to a second relatively more proximal position, theactivation sleeve being biased towards the first position via thespring.
 15. A method of performing surgery as claimed in claim 11,wherein the implant is an interspinous spacer, and the method furthercomprises positioning wings of the interspinous spacer about first andsecond spinous processes of the patient and compressing the wingsagainst the spinous processes via step (i) of claim
 11. 16. A surgicalsystem comprising: an implant; a first instrument comprising: a body; anactuation member movably engaged to a locking mechanism, whereinmovement of the actuation member from a first position to a secondposition causes the locking mechanism to move from an unlocked state toa locked state; a connection mechanism engageable with the implant,wherein, after engagement of the connection mechanism with the implant,movement of the locking mechanism from its unlocked state to its lockedstate locks the connection mechanism to the implant, and movement of thelocking mechanism from its locked state to its unlocked state unlocksthe connection mechanism from the implant, the implant being rotatablewhile engaged to the connection mechanism from a first orientation inwhich the implant has a first footprint in a horizontal direction to asecond orientation in which the implant has a second footprint in thehorizontal direction smaller than the first footprint; and an activationsleeve engaged to a pivoting member, the pivoting member being rotatablerelative to the activation sleeve from a first orientation in which thepivoting member has a first footprint in the horizontal direction to asecond orientation in which the pivoting member has a second footprintin the horizontal direction smaller than the first footprint, whereinthe pivoting member has a surface shaped to contact the implant andretain the implant in its second orientation when the pivoting member isin its second orientation.
 17. A surgical system as claimed in claim 16,wherein the pivoting member is engaged with a spring that biases thepivoting member towards its first orientation.
 18. A surgical system asclaimed in claim 16, wherein the activation sleeve is engaged with aspring that biases the activation sleeve and the pivoting member in adistal direction.
 19. A surgical system as claimed in claim 16, furthercomprising a drive shaft operatively engaged to the actuation member andto the locking mechanism, the actuation member comprising a knobrotatably engaged to the instrument, wherein rotation of the knobrelative to the instrument causes longitudinal movement of the driveshaft, thereby resulting in movement of the locking mechanism from itsunlocked state to its locked state.
 20. A surgical system as claimed inclaim 16, wherein the pivoting member is movable in a longitudinaldirection from a first distal position to a second more proximalposition and, when the pivoting member is in the first distal positionwith the surface of the pivoting member engaged to the implant, thepivoting member and the implant are fixedly secured their secondorientations.